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Risk areas for pediatric acute care: asthma differs from upper and lower respiratory illness
Carol J Blaisdell1, Robert LoCasale, Ana Gu
1Department of Pediatrics and Physiology, University of Maryland School of Medicine, MD, USA. cblaisdell@peds.umaryland.edu
Insights
Pediatric emergency department (ED) visits for respiratory illnesses in urban areas are linked to geographic disparities. While poverty influences overall ED use, specific environmental factors may drive asthma ED visits differently than upper and lower respiratory infections.
Area of Science:
- Pediatric Emergency Medicine
- Environmental Health
- Urban Public Health
Background:
- Emergency department (ED) utilization for pediatric respiratory illness can vary significantly within urban environments.
- Understanding geographic disparities in ED use is crucial for targeted public health interventions.
Purpose of the Study:
- To investigate whether pediatric emergency department utilization for respiratory illnesses differs across small geographic areas within a large city.
- To identify potential geographic and socioeconomic factors influencing these disparities.
Main Methods:
- Retrospective analysis of Maryland Health Services Cost Review Commission Emergency Department discharge data.
- Inclusion of all non-neonatal Baltimore City residents under 18 years old with respiratory diagnoses from April 1997 to December 2000.
- Calculation of crude and adjusted ED visit rates for asthma, upper respiratory infections (URI), and lower respiratory infections (LRI), comparing odds across city regions.
Main Results:
- High ED utilization rates for upper and lower respiratory illnesses, and non-respiratory illnesses, correlated with regions of high ED utilization for asthma, even after adjusting for demographics.
- Regions with high odds of asthma ED visits differed from those with high odds for URI or LRI when poverty was controlled for.
Conclusions:
- Poverty appears to be a significant factor in overall high ED utilization in urban settings.
- Environmental exposures contributing to asthma ED visits may differ from those leading to URI and LRI, suggesting distinct environmental influences.
Objective:
To determine if emergency department utilization for pediatric respiratory illness varies across small geographic jurisdictions within a large urban city.
Design:
A retrospective analysis of Maryland Health Services Cost Review Commission Emergency Department discharge data.
Setting/Patients:
All non-neonatal, Baltimore City residents <18 years old with valid diagnoses admitted and discharged from emergency departments (ED) in the state of Maryland from April 1, 1997 to December 31, 2000 (n=245,339).
Main Outcome Measures:
Crude and adjusted ED visit rates for asthma, upper and lower respiratory illnesses (per 1000 population). To evaluate the effect of geography on pediatric ED visit rates, odds of an asthma ED visit, URI, or LRI vs. non-respiratory ED visit were compared across regions of the city.
Results:
We determined that residential areas with high ED utilization rates for upper and lower respiratory illnesses, as well as non-respiratory illnesses correlate with regions of high ED utilization for asthma, even after adjusting for race, gender and age of the population. The regions with high odds ratios that an ED visit was for asthma were different from those with high ORs for URI and LRI after also controlling for poverty.
Conclusions:
This suggests that poverty accounts for high utilization of the ED in urban settings, but suggests that environmental exposures that increase the risk of ED care for asthma differ from those that lead to URI and LRI.
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